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Funding Acknowledgements Type of funding sources: None. BACKGROUND & PURPOSE. Cardiac amyloidosis (CA) is an infiltrative disorder characterized by left ventricular (LV) thickening with early systolic and diastolic dysfunction. Due to it poor prognosis, and the beneficial impact of novel treatments when started in early stages of disease, its forward detection is crucial. Aim of this study is comparing the diagnostic accuracy of classical and novel echocardiographic parameters in detecting CA among other forms of genetic and non-genetic cardiomyopathies with hypertrophic phenotype. METHODS. We enrolled 50 pts with CA (26 AL and 24 wtATTR) and 75 phenocopies (LVH group) [25 hypertrophic cardiomyopathy (HCM) pts, 25 hypertensive (HypCM) pts, and 25 pts with non-severe aortic stenosis (AS)]. Standard and novel LV morpho-functional echo parameters [LV ejection fraction (LVEF), myocardial contraction fraction (MCF), global longitudinal strain (GLS), relative regional strain ratio (RRSR), ejection fraction on strain ratio (EFSR)], and novel Myocardial Work (MW) parameters [Global Work Index (GWI), Global Constructive Work (GCW), Global Wasted Work (GWW), Global Work Efficiency (GWE)] were analyzed. RESULTS. LV standard, novel and MW-derived systolic parameters were more impaired in CA compared to LVH group. At ROC curve analysis, GCW showed the best performance in discriminating CA from other forms of LVH (AUC 0.886; 95% CI: 0.819-0.954; P CONCLUSIONS. Despite CA and LVH patients shows a similar phenotype, the systolic function differs greatly. In the present study, the GCW showed the best ability in detecting CA among other forms of LVH. Its reduction in CA seems reflect the infiltrative burden and its consequences on myocardial deformation properties, while its reduction in LVH group has been attributed elsewhere to fibrotic derangement. GCW showed to be a promising novel diagnostic and prognostic factor in this setting. Abstract Figure 1 Abstract Table 1

Funding Acknowledgements Type of funding sources: None. BACKGROUND & PURPOSE. Left atrial function (LAF) is a determinant of clinical status and outcome in many cardiac disorders, including cardiac amyloidosis (CA). Aim of this study is to explores the LAF in CA and other cardiomyopathies with hypertrophic phenotype, and its consequences on cardiovascular haemodynamics, right ventricular function and survival. METHODS. We enrolled 50 patients with CA (26 AL and 24 wtATTR) and 75 with hypertrophic phenotype (LVH group) [25 hypertrophic cardiomyopathy (HCM) pts, 25 hypertensive pts (HypCM), and 25 pts with aortic stenosis (AS)]. LAF was analysed using the phasic method [LAEI as reservoir, LAPEF as conduit, LAAEF as active pump and TLAEF as total emptying function; see figure 1] by LA volumes determination. RESULTS. ATTR patients showed higher LA dimensions and impaired reservoir and total LA emptying function (TLAEF) compared to AL without differences LAF. Compared to the LVH group, CA patients showed higher LA dimension with impaired LAF in all phasic parameters, higher LV filling pressures and reduced biventricular function. We further divided CA and LVH patients into four subgroups based on the presence or absence of LA dysfunction (LADys+ for TLAEF values below the median: CONCLUSIONS. LAF is significantly more impaired in CA than LVH group and is associated with worst clinical status, RV dysfunction and higher LV filling and pulmonary pressure. Moreover, LADys is a frequent feature of CA and significantly associated with higher CV mortality. We suggests that LADys in LVH group could results from chronic pressure overload due to LA"s exposure to high LV diastolic pressure (impaired LV compliance). In CA, LADys could also be determined by direct LA infiltration. The pathophysiological result is a progressive LA remodelling with increased LA pressure, consequent backward transmission to the pulmonary venous system and, ultimately, RV dysfunction. TLAEF is parameter of LAF that correlates with increased pulmonary vascular resistance (measured elsewhere with cardiac catheterisation) and RV dysfunction. In CA, it seems promising as marker of the haemodynamic consequences of LADys and CV mortality. Abstract Figure 1 Abstract Figure 2

Funding Acknowledgements Type of funding sources: None. BACKGROUND & PURPOSE. Right ventricular (RV) dysfunction in cardiomyopathies is a consequence of chronic overload (i.e. aortic stenosis, AS) or direct involvement of systemic disorders (i.e. cardiac amyloidosis, CA). The Tricuspid Annular Plane Systolic Excursion/Systolic Pulmonary Artery Pressure (TAPSE/sPAP) ratio has been recently proposed as a surrogate of RV-arterial coupling (RVAC). This study aims to compare RVAC between CA subgroups and between CA and other forms of genetic and non-genetic cardiomyopathies with hypertrophic phenotype. METHODS. We enrolled 50 patients with CA (26 AL and 24 wtATTR) and 75 cardiomyopathies with hypertrophy phenotype (LVH group) [25 pts with hypertrophic cardiomyopathy (HCM), 25 hypertensive pts(HypCM), and 25 pts with AS]. Besides routine echocardiographic measurements, we analysed right chambers dimensions and classical and novel parameters of RV function [TAPSE, TAPSE/sPAP, St wave, global (RVGLS) and free-wall (RVFWS) strain]. RESULTS. Compared to AL, the ATTR group showed higher right chambers dimensions, without differences in all RV systolic parameters. Compared to the LVH group, CA patients showed no differences in RV dimensions while RV systolic parameters, including the TAPSE/sPAP ratio, were significantly reduced in the presence of significantly higher LV filling pressures. At ROC curve analysis, TAPSE (AUC 0.877; 95% CI: 0.811-0.943; p CONCLUSIONS. The RVAC is significantly impaired in CA compared to the LVH group but not between CA subgroups. Its reduction seems attributable to both increase LV filling pressure, due to the restrictive nature of the infiltrative cardiomyopathy, and reduced RV systolic function, due to either indirect RV chronic overload and direct myocardial infiltration. The TAPSE/sPAP ratio is a surrogate of RVAC and proved to be a novel echocardiographic parameter useful in both discriminating CA among genetic and non-genetic forms of LVH, and stratifying the prognosis. Abstract Table 1 Abstract Figure 1

Coronal mass ejections (CMEs) are large eruptions of magnetized plasma from the Sun that play an important role in space weather. The key to understanding the fundamental physics of a CME is measurement of the plasma properties within heliocentric distances of $< 20~\mathrm{R}_{\odot }$ . Faraday rotation, a radioastronomical propagation measurement, is an extremely valuable diagnostic for studying CMEs. Faraday rotation measurements [RM] contain information on the magnetic field in the medium causing the Faraday rotation. Recent observations of CME-induced Faraday rotation (e.g., Howard et al. in Astrophys. J. 831, 208, 2016; Kooi et al. in Solar Phys. 292, 56, 2017; Bisi et al. in EGU General Assembly Conference Abstracts, 13243, 2017) have all been restricted to a single line of sight (LOS) and, therefore, limited to providing estimates of the magnetic field strength. Modeling by Liu et al. (Astrophys. J. 665, 1439, 2007) and Jensen and Russell (Geophys. Res. Lett. 35, L02103, 2008) demonstrated that multiple LOS are necessary to recover the magnetic field strength and structure of the observed CME. We report the first successful observations of Faraday rotation through a CME using multiple lines of sight: 13 LOS across seven target radio fields. We made these radio observations using the Karl G. Jansky Very Large Array (VLA) at $1-2$ GHz frequencies in the triggered operation mode on 31 July 2015, using a constellation of cosmic radio sources through the solar corona at heliocentric distances of $8.2-19.5~\mathrm{R}_{\odot }$ . For LOS within $10~\mathrm{R}_{\odot }$ , the CME’s contribution to the measured RM was $\approx 0$ to −20 rad m−2, a significant enhancement over the coronal contribution. We assumed a force-free flux-rope structure for the CME’s magnetic field and explored three separate models for the CME’s plasma density: constant density, thin shell, and thick shell. The plasma densities and axial magnetic field strengths for the three models ranged over $5.4-6.4\times 10^{3}$ cm−3 and $26-35$ mG, respectively. Further, using all 13 LOS, we successfully determined the CME’s orientation and helicity.

The use of fiber-reinforced composite materials to replace steel for the construction of structural concrete elements is a common practice in many countries of the world. In Italy, although attention to this type of reinforcement has been manifested for some time and the scientific and technical community of our country has promptly engaged in the drafting of a Technical Document on the topic, published in 2007 by the CNR and entitled Instructions for the Design, Execution and Control of Reinforced Concrete Structures with Fiber-Reinforced Composite Material Bars, the Technical Standards for Construction issued by the Ministry of Infrastructures and Transportations (MIT) have so far not allowed unrestricted use. The use is subjected, on a case-by-case basis, to its approval by the Superior Council of Public Works. Only in May 2018, MIT set up a Working Group for the drafting of two Guidelines: one on the identification, qualification and acceptance of FRP bars (QGL) and another on the design of concrete structures reinforced with such bars (DGL). At the moment the two Working Groups have released the two draft Guidelines, which are currently being examined by a rapporteur commission in view of the discussion by the Assembly of the Superior Council of Public Works, the competent approval, with any amendments, and subsequent publication, the latter hopefully expected by the current year 2021. The essential contents of the two Guidelines are summarized herein.

The examination of the aging behavior of polymers, blends, composites, items, etc. under different environmental conditions is a priority issue for assessing the possible applications and establishing the lifetime. In agriculture, plastic items (mulch films, irrigation tubes, etc.) are widely used and subjected to solar UV exposure that can induce photo-oxidation on macromolecular chains. Therefore, weathering under outdoor conditions and accelerated degradation tests are performed for simulating aging processes during the lifetime of materials and select appropriate stabilizers to be used. In the last decades, oxo- and biodegradable polymers have been investigated and used in agricultural items. The influence of photooxidation or outdoor weathering on their structures, performance and biodegradation behavior in soil has been evaluated. This review aims to provide an overview of the studies focused on the effects of photo-degradation processes on chemical-physical properties and degradation in soil of oxo- and biodegradable polymers or items designed for agricultural purpose, including an outline of the available standards. Additionally, a comparison between the behaviors induced by photo-oxidation of the two different families of degradable polymers used in agricultural plastic items is carried out.

Polycarbonate (PC) is a good material for covering and protecting cultural heritage sites because of its durability, mechanical properties, and transparency. When bisphenol A polycarbonate is subjected to weathering conditions this polymer shows several degradation processes depending on the irradiation wavelength, humidity and temperature. In particular, the combined effects of humidity and UV irradiation speed up the PC molecular weight reduction. In this work, the decomposition mechanisms associated to the hydrolysis process are scrutinized and the effects of UV irradiation on the hydrolysis process are evaluated throughout the Density Functional Theory (DFT) approach. It was found that under UV irradiation the hydrolysis process is speeded up because of the geometrical rearrangement due to the photo-Fries process induced by the UV light.

Polycarbonate is a good material for covering and protecting cultural heritage sites because of its durability, mechanical properties, and transparency. However, polycarbonate degrades under environmental weathering with a significant decrease of physical and mechanical properties and loss of transparency. In this work, the contemporary presence of ultraviolet irradiation and different temperature and moisture conditions have been taken into account to study the environmental degradation of this polymer with regard to its mechanical and optical properties. The photo-oxidation reactions cause a decrease in the molecular weight and the formation of many oxygenated species. The hydrolytic scission, instead, gives rise to a remarkable reduction in the molecular weight. These two different degradation mechanisms do not seem interconnected because at the lowest degradation temperature and high humidity levels, the reduction of the molecular weight is more pronounced than that observed at the highest temperature but at a lower humidity level. Transparency decreases with the degradative processes, but even after severe degradation the loss of transparency is only about 10%. The yellowness index increases during the first stages of degradation, which has been attributed to the fast formation of carbonyl groups due to photo-oxidation.

In biodegradable polymer world nanobiocomposites represent a new group of materials filled with inert nanoparticles that shows very interesting properties and the biodegradability of the matrix. In this work we have studied the effect of the polarity of the organomodified montmorillonite and of the elongational flow on the morphology and the rheological and mechanical properties of a new nanobiocomposite with a matrix of biodegradable PLA based blend. The elastic modulus enhances in presence of the nanofiller and this increase is larger and larger with the increment of the orientation. The tensile strength does not show any significant change at the same level of orientation. Moreover, a brittle-to-ductile transition is observed in the anisotropic sample and this effect is again more evident for the nanocomposite. The raise of the interlayer distance is higher for the more polar montmorillonite, even if the two nanocomposites show about the same final interlayer distance and morphology. Some exfoliation is also observed as a result of the application of the elongational flow.

Polymer films based on biodegradable polymers, polyethylene (PE) and modified PE with oxo-degradable additive were prepared by film blowing. Carbon black (1%) was added to all the films. Commercial biodegradable Ecovio&reg, and Mater-Bi&reg, samples were used. Mechanical properties, soil burial degradation and surface wettability were investigated, before and after UV irradiation. Chemical modifications induced by UV and soil degradation, or a synergic effect, were highlighted by Attenuated Total Reflection-Fourier Transform Infra-Red (ATR-FTIR). Photo-oxidized film samples with an elongation at break equal to 50% and 0.5 the initial value were selected for the soil burial degradation test at 30 &deg, C. Weight loss measurements were used to follow biodegradation in soil. Predictably, the degradation in soil was higher for biodegradable polymer-based films than for the PE-based ones. UV irradiation increased surface wettability and encouraged the disintegration in soil of all the samples. In fact, photo-oxidation produced a molar mass reduction and hydrophilic end groups, thus increasing surface erosion and weight loss. This paper not only supplies new criteria to evaluate the performance of biodegradable films in agriculture, before and after lifetime, but also provides a comparative analysis on the soil burial degradation behaviour with traditional ones.

The rising concerns in terms of environmental protection and the search for more versatile polymer-based materials have led to an increasing interest in the use of polymer composites filled with natural organic fillers (biodegradable and/or coming from renewable resources) as a replacement for traditional mineral inorganic fillers. At the same time, the recycling of polymers is still of fundamental importance in order to optimize the utilization of available resources, reducing the environmental impact related to the life cycle of polymer-based items. Green composites from biopolymer matrix and wood flour were prepared and the investigation focused on several issues, such as the effect of reprocessing on the matrix properties, wood flour loading effects on virgin and reprocessed biopolymer, and wood flour effects on material reprocessability. Tensile, Dynamic-mechanical thermal (DMTA), differential scanning calorimetry (DSC) and creep tests were performed, pointing out that wood flour leads to an improvement of rigidity and creep resistance in comparison to the pristine polymer, without compromising other properties such as the tensile strength. The biopolymer also showed a good resistance to multiple reprocessing, the latter even allowed for improving some properties of the obtained green composites.

Polymer nanocomposites and their behavior have been widely investigated by several paths, including mechanical, rheological, and permeability tests, finding that several parameters (such as the polymer matrix, the nanofiller, their amounts, the presence of compatibilizers, processing parameters, etc.) can influence the main properties. However, less information is available regarding the creep response of polymer nanocomposites; in particular, few or no data are reported about the combined effect of different loads and different temperatures. In this article, the creep behavior of a low density polyethylene/organomodified clay nanocomposite has been investigated. The characterization of viscoelastic response has taken into account both the effects of applied load and temperature, which are often considered separately. Dynamic–mechanical and structural analysis was also performed in order to get a deeper understanding of the involved phenomena. The nanocomposite showed lower creep deformations (up to ∼20%) and the relative differences with the neat polymer matrix were found to be increasing upon increasing the applied load (up to ∼24%) and the temperature (up to ∼38%). © 2016 Wiley Periodicals, Inc. J. Appl. Polym. Sci. 2016, 133, 44180.

Two hundred and 91 patients showing signs and symptoms of bacterial vaginosis (BV) were randomized to receive topical treatment with Fitostimoline (vaginal cream and vaginal ovules + vaginal washing) or benzydamine hydrochloride (vaginal cream + vaginal washing) for 7 days. Signs (leucorrhoea, erythema, oedema, and erosion) and symptoms (burning, pain, itching, vaginal dryness, dyspareunia, and dysuria) (scored 0–3) were evaluated at baseline and at the end of treatment; the total symptoms score (TSS) was also calculated. In 125 patients, a bacterial vaginosis was confirmed by vaginal swab test. The primary efficacy variable analysis, that is, the percentage of patients with therapeutic success (almost complete disappearance of signs and symptoms), demonstrated that Fitostimoline ovules and vaginal cream were therapeutically equivalent and that pooled Fitostimoline treatment was not inferior to benzydamine hydrochloride. All the treatments were well tolerated, with only minor local adverse events infrequently reported. The results of this study confirmed that gynaecological Fitostimoline is a safe and effective topical treatment for BV.

Linear hyperbranched block copolymers based on PBA polyesters (HPBA) has been synthesized by a one‐pot synthesis procedure and well characterized by MALDI‐TOF mass spectrometry, H‐NMR and SEC tools, to obtain reliable information on its chemical composition and molar mass distribution.

We evaluated whether the dobutamine stress-echo test can select responders to cardiac resynchronization therapy (CRT). Up to 50% of patients do not respond to CRT. Lack of response may be due to a significant amount of scar or fibrotic tissue at myocardial level.We studied 42 CRT patients. After clinical and echocardiographic evaluation, all patients underwent a dobutamine stress-echo test to assess contractile reserve. Cut-off for the test was an increase of 25% of the left ventricular ejection fraction. Patients were implanted with a CRT-defibrillator and followed up at 6 months. Cut-off for CRT response was a reduction of 15% of left ventricular end-systolic volume. Twenty-five patients responded to CRT; all of them showed presence of contractile reserve. The test showed a sensitivity of 100% and a specificity of 88%.Contractile reserve was a strong predictive factor of response to CRT in the studied population.

The response to CRT is largely determined by the baseline degree of interand intraventricular dyssynchrony, and echocardiography seems to be the ideal technique by which to identify responders to CRT.At present the definition of echocardiographic indices of ventricular dyssynchrony is undergoing intense research, and several indices have been proposed that may or may not prove useful in a prospective evaluation. It is time for a prospective trial to evaluate these different parameters with regard to their impact on the efficacy of CRT. These data will provide a better basis for the clinical decision as to which heart failure patients are likely to benefit from this new form of therapy.

The distribution and magnitude of left ventricular (LV) hypertrophy are not uniform in patients with hypertrophic cardiomyopathy (HCM), which results in regional heterogeneity of LV systolic and diastolic function. The aim of the study was to evaluate LV regional systolic asynchrony in patients with HCM by pulsed Doppler myocardial imaging (DMI).We studied 35 HCM patients and 45 age- and sex-matched controls. By the use of DMI, the following five different basal myocardial segments were measured: systolic peak velocity (Sm); early- and late-diastolic peak velocities; pre-contraction time (Q-Sm) (from the beginning of Q-wave of ECG to the onset of Sm); intraventricular systolic delay (IntraV-Del) (difference of Q-Sm in different LV myocardial segments); interventricular delay (InterV-Del) (difference of Q-Sm between the most delayed LV segment and right ventricular lateral wall).DMI analysis showed in HCM lower myocardial systolic and early-diastolic peak velocities of all the analyzed segments. As for time intervals, controls showed homogeneous systolic activation of the ventricular walls. Conversely, HCM group, despite the absence of intraventricular conduction defects by surface ECG, showed significant both Inter- and IntraV-Del (P0.0001). Linear regression models pointed out independent positive associations of IntraV-Del with LV outflow gradient and septal wall thickness in HCM (P0.001). An IntraV-Del30 msec well differentiated controls and HCM. In addition, an IntraV-Del45 msec (ROC curve) identified a subgroup of HCM patients with nonsustained ventricular tachycardia during Holter monitoring (90.9% sensitivity and 95.8% specificity).The impairment of intrarventricular systolic synchronicity is strongly related to increased septal thickness and LV outflow-tract gradient in HCM. DMI analysis may be able to select subgroups of HCM patients at an increased risk of ventricular tachyarrhythmias.

Cerebrovascular mortality represents 25% of all cardiovascular mortality. Defining the pathological mechanism of an episode of ischemic stroke is important for epidemiological, prognostic and overall therapeutic purposes. About 1/4 of ischemic strokes are defined as being of unknown cause. The use of transesophageal echocardiography for studying the aortic arch and thoracic aorta, revealed that aortic atheroma can be considered as an embolic source. Retrospective studies documented a significant prevalence of atheroma4 mm in the aortic arch in patients with previous stroke (15%); while prospective studies documented an increased risk for cardiovascular events in patients with plaque of =/4 mm in thickness at the level of the thoracic aorta compared with controls without these lesions: in particular, the incidence of recurrent stroke is 12%/year, while the incidence of cardiovascular events is 26%. Plaques defined unstable and at risk of embolic event are protrudent,4 mm in thickness, without calcification and have on their surface mobile thrombus. Embolization from a protrudent atheroma can have a iatrogenic cause, that is cardiac catheterization or placement of an intra-aortic balloon- pump or during cardiopulmonary bypass. The management of the subject with aortic atheroma is not well defined. Encouraging dates with the use of statins are from a recent meta-analysis also anticoagulant treatment versus antiplatelet treatment, reduced incidence of stroke in a significant manner. The surgical therapy of aortic endoarterectomy, has, at this moment, a limited indication, because is not without risk. Transesophageal ecocardiography is a method of choice for the study of the aortic atheroma and it should be done in every patient with stroke by unknown cause.

The vascular endothelium has a central role in regulating vasomotor tone, smooth muscle cell proliferation, platelet and leukocyte adhesion to the arterial wall, thrombosis and fibrinolysis. Disturbances of these endothelial functions have been suggested to be important in the early and advanced phases of atherosclerosis. The development of a simple, valid ultrasound-based method allowed to non-invasively evaluate endothelial function in a large number of individuals with traditional and non-traditional cardiovascular risk factors. The ultrasound technique measures changes in brachial artery diameter in response to an increase in blood flow (reactive hyperemia) and thus in shear stress, which causes endothelium-dependent dilation. This methodology is not yet perfect. The critical issues today involve the definition of "normal values", and standardized scanning and reading protocols to reduce variability.

Over the last decade, it has become progressively clear that the most important mechanism responsible for acute coronary and cerebrovascular events is atherosclerotic plaque rupture with superimposed thrombus formation. Anatomo-pathological studies have shown that the risk of rupture depends on plaque type rather than plaque size. The determinants of carotid plaque vulnerability to rupture are similar to those responsible for coronary instability: 1) size and consistency of the lipid-rich atheromatous core, 2) ongoing inflammation and repair processes within the fibrous cap, and 3) the thickness of the fibrous cap covering the core. Unstable plaques contain a soft, lipid-rich core that is covered by a thin and inflamed cap of fibrous tissue. External factors such as mechanical and hemodynamic stresses may be important not only in precipitating disruption of vulnerable plaques, but also in their cellular differentiation. Several imaging techniques have been used to identify plaques at high risk of events. High-resolution B-mode ultrasound is a noninvasive, inexpensive technique which allows a characterization of carotid plaque dimension, internal structure and surface. Nevertheless, such a method is not perfect. The subjective evaluation of plaque morphology on B-mode ultrasound, the need of improving reproducibility and the lack of a uniform terminology are critical issues, which need to be addressed.

The aim of this study is to determine the rate of vertical transmission of hepatitis C and to analyse the concomitant infection by HIV as a risk factor.We have studied the perinatal transmission of HCV in 22 pregnancies: 14 in women HCV+/HIV-, 8 in women HCV+/HIV+. We have performed the following tests on sera: test RIBA II to search for Ab anti-HCV, alanine transaminase (ALT) evaluation and HCV-RNA research by PCR. These tests were performed on sera from infants at birth and, then, during one year every three months.Within one year Ab anti-HCV disappeared in 20 of 22 pregnancies: two infants positive by Ab anti-HCV were born to HIV+ mothers and they were the only two who showed abnormal ALT values and detectable levels of HCV-RNA. Finally 10 of 14 infants born to HCV+/HIV- mothers were breast-fed and none was infected.We conclude that HCV mother-to-child transmission is an uncommon event, breast-milking is safety, and the concomitant infection by HIV could represent a risk factor for vertical transmission of hepatitis C.

Paravalvular abscesses are a serious complication of aortic endocarditis. Echocardiography is the method of choice for the visualization of the valve-attached vegetations, however the detection of endocarditis-associated abscesses by transthoracic approach is extremely difficult. Recently transesophageal echocardiography has been proved as an excellent tool to correctly detect these lesions. We report on two patients with endocarditis-associated abscesses in whom transesophageal echocardiography allowed us to diagnose paravalvular abscesses not recognized by transthoracic echocardiography; furthermore in the first patient, performing two successive transesophageal examinations before and after antibiotic therapy, we could follow the evaluation of aortic abscess which became a fistula draining into the left ventricular outflow tract. In conclusion these two cases suggest that transesophageal echocardiography should be always performed in patients suspected or known to have endocarditis and that a following examination is indicated to assess any evolving echocardiographic finding.

We attempted to determine the relevance and relative prevalence of autonomic dysfunction in 7 patients with end-stage renal disease (ESRD) but no heart disease, 8 patients with left ventricular dysfunction (LVD) with no renal disease and 8 patients with ESRD + LVD. In each group, the assessment of autonomic function and location of the lesion was performed by using the baroreflex sensitivity tests, based upon heart rate (ie Valsalva, deep breathing, lying to standing) to study the parasympathetic system as well as based upon blood arterial pressure (ie standing and sustained handgrip) to evaluate the sympathetic system. The same tests were performed in 7 healthy volunteers enrolled as control group. Separate studies were performed on the efferent parasympathetic arc (atropine test) and the efferent sympathetic arc (cold pressor test). There was evidence of parasympathetic damage in 100% of ESRD patients, in 87.5% of ESRD + LVD patients, and in 62.5% of LVD. Only 1 of ESRD patients showed defective response to atropine whereas the remaining had a normal response, suggesting an afferent lesion alone. No abnormalities were found in the response to cold pressor test, thereby suggesting a lack of involvement of the efferent sympathetic arc. The response to handgrip was higher in LVD patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Echocardiographic assessment of left ventricular mass (LVM) and mass/volume ratio (LVM/V) is an accurate method for evaluating left ventricular hypertrophy. However, reference values for LVM and left ventricular volume (V) in children under 6 years of age have not been well established.Therefore, we evaluated 106 consecutive children (60 males, 46 females, mean age +/- SD 35 +/- 28 months, range 0-72) free of cardiovascular disease by clinical, electrocardiographic and echocardiographic examination. LVM and V were determined by M-mode echocardiography.The 5th and 95th percentile values of LVM were: 7 and 21 grams for infants aged 0 to 6 months; 13 and 32 grams for 7 to 24 months; 23 and 41 grams for 25 to 36 months; 23 and 59 grams for 37 to 48 months; 30 and 60 grams for 49 and 60 months; 36 and 98 grams for 61 and 72 months. The 5th and 95th percentile values of V were: 4 and 20 ml for infants aged 0 to 6 months; 12 and 36 ml for 7 to 24 months; 16 and 43 ml for 25 to 36 months; 20 to 55 ml for 37 to 48 months; 27 to 64 ml for 49 to 60 months; 39 to 74 ml for 61 to 72 months. The 5th and 95th percentile values of M/V ranged between 1 and 2.3 for infants aged 0 to 6 months, and 0.7-1.2 for those aged 61 to 72 months. LVM, V and LVM/V were significantly (p0.0001) related to age, height, weight and body surface area, but were unrelated to gender.

Our purpose was to retrospectively evaluate major risk of non cardiac surgery in patients with valvular heart disease. We studied retrospectively 136 patients, 44 affected by aortic, 81 by mitral and 11 by mitroaortic valve disease. NYHA class was I-II in 130 and III in 6 patients. Sixty four patients underwent orthopedic surgery, 57 patients occulistic surgery and 5 patients urological surgery. There were no hospital deaths. Fifteen patients developed major perioperative complication: 7 serious ventricular arrhythmias, 6 hypotension, 2 "hypertensive attacks". We conclude that non cardiac surgery is safe in patients with valvular heart disease.